It seems like only yesterday — and we can certainly be thankful it wasn’t — that many U.S. hospitals and healthcare workers felt unprepared to deal with a potential incoming case of Ebola linked to the outbreak in Western Africa.
The 2014-2015 outbreak spread to some 28,000 cases and caused more than 11,000 deaths. One of them was a patient admitted to a hospital in Dallas in October 2014. He died, but infected two nurses, who survived. There was considerable confusion about the case, and some initial speculation that the nurses must have had a break in infection control technique. While the exact route of transmission was not determined, a report by an expert investigative panel described a chaotic scene where any number of factors could have led to the occupational infections. Healthcare workers were confused and “lost confidence” trying to protect themselves with PPE guidelines that were in flux at that critical time, the expert panel concluded.
As a result of the Ebola outbreak, the American Nurses Association has entered into training and resource collaborations with both the CDC and the Association for Professionals in Infection Control and Epidemiology (APIC).
“The ANA has been involved in infection prevention and control for quite some time, ranging from antibiotic stewardships to preventing HAIs, but after the Ebola outbreak in 2014 we wanted a more formalized collaboration between ourselves, the CDC, and APIC,” says Seun Ross, DNP, MSN, CRNP-F, NP-C, NEA-BC, director of nursing practice and work environment at the ANA.
“Through these partnerships, we want to ensure that nurses are prepared for any infection that may bubble up.”
The nurse-patient relationship is arguably the most critical aspect of care delivery, and the ANA is particularly proud that nurses are consistently ranked as the most ethical of all professions.
“We have ranked number one in that category for the past 15 years and that is a position we don’t want to concede,” Ross says. “We want to continue that trust [in nursing as an ethical profession]. We want to make sure that nurses are knowledgeable to handle anything that comes their way. Certainly, emerging infectious diseases are in that category and may involve at any time a different understanding of [infection control recommendations]. We want to do everything we can to minimize any concern or hesitation on the part of the nurse.”
One result of this effort is the creation of the ANA/APIC resource center, a website for nurses with a wealth of information on all aspects of infection prevention (http://www.nursingworld.org/ANA-APIC).
In addition, the ANA has collaborated with CDC to form the Nursing Infection Control Education (NICE) Network. The plan is to present CDC training materials at conferences and meetings of nursing specialty groups.
“The CDC is developing a basic training program and we are going to take it and gear it more toward nurses for ANA and some 20 other nursing associations,” Ross says. “We will do it in collaboration with them at each of their conferences so we can reach a broader range of [nursing specialties]. After nursing school, once you get your first job, every hospital does basic infection control. With the NICE Network we plan on teaching hand hygiene, PPE, fundamental principles, and prevention of infection transmission. We will use all of that as a baseline and expand on that and talk more about emerging infections like SARS, MERS, Ebola, etc.”
The training will be conducted at meetings of key nursing groups that include the:
- American Association of Critical-Care Nurses;
- American Association of Occupational Health Nurses;
- Association of periOperative Registered Nurses;
- Emergency Nurses
Association.
The NICE initiative with ANA will address the challenges of emerging infections like Ebola, but will go beyond the widely reported problems with PPE during the outbreak.
“This is about a lot more than PPE,” says Michael Bell, MD, an epidemiologist in the CDC Division of Healthcare Quality Promotion. “A lot of this is about recognizing risk. This is not another review of hand hygiene. It is more about explaining risk — the ‘why’ in infection control. It’s also not just infection preventionists. It’s for all nurses. Preventing infections across the board is huge.”
The ANA will serve as the primary contractor for the project, which runs through May 31, 2018. Key aspects include developing educational tools and outreach materials for both registered nurses and nursing-related professionals, including licensed practical nurses (LPNs) and certified nursing assistants (CNAs), the ANA reports.
Nurses are the on the front line of patient care, but the ANA reminds that they may also be involved as need warrants in environmental cleaning and disposal of hazardous waste. Of course, as workers protect themselves though PPE and infection control measures, the other critical area of emphasis is to prevent cross-transmission between patients.
In additional Ebola education efforts, the federal government has awarded $12 million over the next five years for training development at three hospitals that all cared for infected patients in their respective biocontainment units during the outbreak.1 The facilities participating in the collaborative training and education effort are Emory University in Atlanta; the University of Nebraska Medical Center in Lincoln; and Bellevue Hospital Center in New York City. Training will include rapid suspect or confirmed case identification and immediate isolation as well as appropriate donning and doffing of PPE.
Editor’s note: “The Expert Panel Report to Texas Health Resources Leadership on the 2014 Ebola Events” is available at: http://bit.ly/1R7j0oP.
REFERENCE
- Cummings KJ, Choi MJ, Esswein EJ, et al. Addressing infection prevention and control in the first U.S. community hospital to care for patients with Ebola virus disease: Context for national recommendations and future strategies. Ann Intern Med 2016;165:41-49.
It seems like only yesterday — and we can certainly be thankful it wasn’t — that many U.S. hospitals and healthcare workers felt unprepared to deal with a potential incoming case of Ebola linked to the outbreak in Western Africa.
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